Intensive Care Medicine

, Volume 36, Issue 5, pp 790–798 | Cite as

Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score

  • Boris Jung
  • Nathalie Embriaco
  • François Roux
  • Jean-Marie Forel
  • Didier Demory
  • Jérôme Allardet-Servent
  • Samir Jaber
  • Bernard La Scola
  • Laurent Papazian
Original

Abstract

Objective

Early and adequate treatment of ventilator-associated pneumonia (VAP) is mandatory to improve the outcome. The aim of this study was to evaluate, in medical ICU patients, the respective and combined impact of the Clinical Pulmonary Infection Score (CPIS), broncho-alveolar lavage (BAL) gram staining, endotracheal aspirate and a biomarker (procalcitonin) for the early diagnosis of VAP.

Design

Prospective, observational study

Setting

A medical intensive care unit in a teaching hospital.

Patients

Over an 8-month period, we prospectively included 57 patients suspected of having 86 episodes of VAP.

Intervention

The day of suspicion, a BAL as well as alveolar and serum procalcitonin determinations and evaluation of CPIS were performed.

Measurements and main results

Of 86 BAL performed, 48 were considered positive (cutoff of 104 cfu ml−1). We found no differences in alveolar or serum procalcitonin between VAP and non-VAP patients. Including procalcitonin in the CPIS score did not increase its accuracy (55%) for the diagnosis of VAP. The best tests to predict VAP were modified CPIS (threshold at 6) combined with microbiological data. Indeed, both routinely twice weekly performed endotracheal aspiration at a threshold of 105 cfu ml−1 and BAL gram staining improved pre-test diagnostic accuracy of VAP (77 and 66%, respectively).

Conclusion

This study showed that alveolar procalcitonin performed by BAL does not help the clinician to identify VAP. It confirmed that serum procalcitonin is not an accurate marker of VAP. In contrast, microbiological resources available at the time of VAP suspicion (BAL gram staining, last available endotracheal aspirate) combined or not with CPIS are helpful in distinguishing VAP diagnosed by BAL from patients with a negative BAL.

Keywords

Ventilator-associated pneumonia Procalcitonin Clinical pulmonary infection score Bronchoalveolar lavage Endotracheal aspiration 

Abbreviations

VAP

Ventilator-associated pneumonia

EA

Endotracheal aspiration

BAL

Broncho-alveolar lavage

FiO2

Fraction of inspired oxygen

ICU

Intensive care unit

MCPIS

Modified clinical pulmonary infectious score

SAPS II

Simplified Acute Physiology Score

SOFA

Sequential Organ Failure Assessment Score

PTC

Protected telescoping catheter

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Boris Jung
    • 1
  • Nathalie Embriaco
    • 2
  • François Roux
    • 3
  • Jean-Marie Forel
    • 2
  • Didier Demory
    • 2
  • Jérôme Allardet-Servent
    • 2
  • Samir Jaber
    • 1
  • Bernard La Scola
    • 4
  • Laurent Papazian
    • 2
  1. 1.Intensive Care Unit, Department of Anesthesiology and Critical Care B (DAR B)Centre Hospitalier Universitaire (CHU) Montpellier, INSERM ERI 25MontpellierFrance
  2. 2.Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Marseille, URMITE CNRS-UMR 6236Université de la MéditerranéeMarseilleFrance
  3. 3.Service central de Biophysique et de Médecine Nucléaire, Nuclear MedicineAssistance Publique-Hôpitaux de MarseilleMarseilleFrance
  4. 4.Unité des Rickettsies, Faculté de MédecineUniversité de la MéditerranéeMarseilleFrance

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